Provider Demographics
NPI:1982148623
Name:JACOBS, BARRY WEBSTER (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:WEBSTER
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11086 MILL STONE LN
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-5009
Mailing Address - Country:US
Mailing Address - Phone:703-508-5685
Mailing Address - Fax:
Practice Address - Street 1:11086 MILL STONE LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-5009
Practice Address - Country:US
Practice Address - Phone:703-508-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional